Evaluation of crosslinked and noncrosslinked biol

Authors: L E de Castro Brás S Shurey P D Sibbons

Publish Date: 2011/07/31

Volume: 16, Issue: 1, Pages: 77-89

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Abstract

Abdominal wall defects and incisional hernias represent a challenging problem Currently several commercially available biologic prostheses are used clinically for hernia repair We compared the performance and efficacy of two noncrosslinked meshes in ventral hernia repair to two crosslinked prostheses in a rodent modelMajor complications were seroma induction 3 mesh types implant extrusion 1 mesh type severe inflammatory and immune responses noncrosslinked mesh fibrosis and mineralisation 3 mesh types After inflammation resolution 3 of the matrices tested supported hernia healing but with marked tissue and temporal differences AlloDerm® and Surgisis Gold™ showed tissue reactivity with the host and a rapid rate of matrix remodelling Bard CollaMend™ Implant proved to be inept for hernia repair under the conditions tested Permacol™ biological implant integration with host tissue increased over time supporting hernia healing with strength of tissue and appears to be a safe prosthetic material for ventral hernia repair based on the results of this rodent studyAbdominal wall defects caused by trauma incisional hernias and tumour resection are a common and challenging problem for surgeons The risk of developing an incisional hernia after a midline laparotomy is up to 11 1 The size of the abdominal wall defect and the potential presence of contamination of the site can complicate this commonly performed surgical repair Several methods are available for abdominal wall defect repair Primary closure is used widely but in cases of large defects adequate tissue for direct closure may not be available and most surgeons agree that in such cases the defect should be repaired in a tensionfree manner using a prosthetic mesh material 2 Several synthetic and biologically derived materials have been used clinically to repair abdominal hernias Nonabsorbable synthetic materials are commonly employed polypropylene mesh being the most used 3 4 Although these meshes increase abdominal wall strength by mechanical tension 5 mesh contraction and other serious complications such as adhesions fistula formation skin erosion and increased susceptibility to infection can result 6 In addition subsequent mesh extraction can be difficult due to dense tissue incorporation Therefore the use of nonabsorbable synthetic meshes in contaminated fields has been strongly discouraged on the basis of high rates of morbidity 7 8 Absorbable meshes have also been used for abdominal hernia repair including synthetic and natural materials Biological prostheses are derived from bovine porcine and human sources These are typically collagenbased and treated to remove cellular elements some biomaterials are crosslinked additionally to delay the degradation of the collagen by collagenases 9The purpose of the study reported here was to compare and evaluate Permacol™ biological implant Covidien Dublin Ireland with other biologic prosthetic biomaterials all commercially available and recommended for repair of abdominal wall defects in a rat model Permacol™ biological implant is a dermal collagen porcinederived biomaterial Fat deposits hair follicles sweat glands and cells are removed during the manufacturer’s process deriving an acellular sheet of collagen and its constituent elastic fibres with both proteins maintaining their original threedimensional 3D structure 10 To improve durability Permacol™ biological implant is stabilised chemically by crosslinking with hexamethylene diisocyanate HMDI 11 12 Permacol™ is a crosslinked bioprosthesis currently in clinical use for hernia repair 13 14 15 16The study was designed to include both crosslinked and noncrosslinked meshes A literature research Pubmed was performed to identify the bioprosthesis most commonly used for abdominal wall repair AlloDerm® Regenerative Tissue Matrix™ LifeCell Branchburg NJ is an acellular dermal matrix derived from donated human skin and classified as banked human tissue It is treated to remove both the epidermis and cellular components while maintaining an intact basement membrane and collagen AlloDerm® has been commonly used for ventral hernia repair 17 18 19 20 but several cases of postsurgical complications have been reported 18 21 Surgisis Gold™ Cook Medical Bloomington IN is a porcinederived small intestinal submucosa SIS matrix that is processed to remove all cells The natural composition of SIS is retained and the matrix is constituted by collagen glycosaminoglycans proteoglycans and glycoproteins Surgisis has been evaluated extensively in animal models 22 23 24 and used clinically in several surgical procedures including abdominal hernia repair 25 26 27 At the time the study was designed from the crosslinked biomaterials commercially available Bard CollaMend™ Implant Davol Cranston RI showed the features closest to Permacol™ and therefore to minimize the variables evaluated same biological source was chosen as the second crosslinked implant CollaMend™ is a porous lyophilised acellular porcine dermal collagen matrix It is processed to remove all noncollagenous cellular components and is crosslinked with 1ethyl33dimethylaminopropylcarbodiimide hydrochloride EDC to increase strength and endurance CollaMend™ is currently in clinical use for hernia repair 14 28Male Sprague–Dawley rats were purchased from Harlan Blackthorn UK allowed to acclimatise for at least 1 week prior to the beginning of the study and were monitored daily They were fed a standard rat pelletchow diet Special Diet Services Witham UK and tap water ad libitum throughout the study Animals with weights between 250 and 310 g were selected Body weights were recorded on the day of surgery and on the termination day Animals were distributed randomly within the 12 groups

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